First Trimester Screening, Part I…

I suppose something good came out of the whole insurance debacle I wrote about last time: I got to spend close to 20 minutes seeing my babies via ultrasound during the Nuchal Translucency (NT) Scan.  Because honestly, given that a) my husband is in his mid 30s, b) the egg donor was 29, and c) the embryos were already PGD tested, it isn’t likely that something will show up.  Under typical circumstances with that kind of information, Evil HMO probably wouldn’t have approved it.  Then again, I’ve hit that special “1 in 1000” nail right on the head twice when it comes to dealing with medical issues–so I really wanted to make sure that should it happen a third time, I’m not caught unprepared.

The scan appointment, however, didn’t start off so great.  Our GS got lost on the way to the clinic, so she showed up late.  At first I wasn’t worried, because they told us to be there 30 minutes early.  But then she ended up arriving 20 minutes after the scheduled appointment time, which meant that she was really 50 minutes late.  We walked up to the desk to check in, and the girl told us that they have a “15 minute” policy, where 15+ minutes late = no scan.  But rather than flip my lid, I appealed to her soft side.  I explained that we were only told that the appointment had been approved the morning before, it was scheduled shortly after that, I made travel arrangements in the afternoon, and flew down from the Bay Area the same evening.  To add extra emphasis, I added that I drove 75 minutes to get to the appointment from where I was staying , and my husband and I were spending our anniversary apart because my attending the scan was so important to us.  (Lest anyone think I was taking advantage of her, everything I said was the absolute truth. Well, maybe not the 75 minutes, but only because I was driving way faster than I should have been. 😉 )  When I finished, she asked me in an incredulous voice if I had really bought same-day travel tickets and flew all the way down just for this one appointment.  I replied in the affirmative, and she said that she’d check to see if they could squeeze us in.

2 minutes later we were led back to the room, and the tech started the scan.  And oh, my goodness, the difference between 8 weeks and 13 weeks is incredible.  The heartbeats weren’t just flashing points of light, but actual muscle contractions that I could see pushing the blood through the twins’ bodies.  The arms weren’t just barely-visible bumps, but discernible limbs used to smack each other in the head with and fight like siblings do.  The most poignant moment, though, had to be watching one of them practice opening and closing the mouth.  For some reason, that made me reach for the stool and sit down for the rest of the appointment in awe.

Once the tech was finished getting all the measurements, she left the room and told us that the doctor (a perinatologist) would be there in a bit.  I figured we’d be waiting a while and didn’t mind at all, since they had made accommodations for us to be seen.  During the break, the agency coordinator texted me to inform me that our GS’s first appointment had been moved to the next day, which meant that I could attend it before flying home.  It was definitely a wonderful, unexpected surprise. 🙂

When the peri came in, he cranked up the ultrasound machine again to double check the tech’s work.  At first he claimed that one placenta was anterior and the other was posterior, which was good because it would make it easier to identify one as Baby A and the other as Baby B (until gender became apparent).  But then our GS’s uterus “shifted”, and both placentas were determined to be posterior, with one being high and the other being low.  Both the peri and the tech claimed to have never seen such a thing before, but told me not to worry, as the twins were still just as active.  Had they not mentioned it with such surprise I never would have noticed, being a novice when it comes to pregnancy ultrasounds.

At the end of the appointment, the perinatologist handed me a report and some pictures printed during the ultrasound.  Most of them aren’t too clear, although I think one is a facial profile, and another is a picture of a developing brain.  As amazed as I’ve been thus far by the science and technology we have at our disposal, I’m pretty sure that there’s still a lot left to be seen.

Oh, and I wanted to say thank you for coming back, especially after my ranting in the last post. It’s part of the journey, though, so I’m not going to remove it.  And besides, if a girl can’t rant on her blog, where can she do so? 😉

The “Joys” of Insurance…

For the record, I’ve never had a problem with military insurance–even when seeing doctors that are civilians.  The money is taken out of my account automatically every month, I get a referral from my PCP when I need to see a specialist for the first time, and usually can schedule an appointment within a week–two, at the most.  The appointment itself may not be in that time frame, but at least I can get on the schedule.  In the last 10 years of living with Lupus I’ve seen an assortment of cardiologists, gastroenterologists, nephrologists, neurologists, ophthalmologists, and rheumatologists (still with me?).  There have also been appointments with reproductive endocrinologists, but those were surrogacy-related, not for Lupus. 😉 I’ve been poked, prodded, and punctured to be diagnosed and treated, and have honestly lost count of the number of appointments I’ve had with the various specialists and the techs.

My point is this: in dealing with all those specialists and that insurance, never once did they put me through the kind of stress I’m dealing with now.  Seriously, my hair is falling out more than usual, my sleep schedule is jacked, and my appetite is off–all due to the CF this other insurance company has created with my surrogate (for those who don’t know, in this case CF is an abbreviation for Charlie-Fox, or ClusterF*ck).  While most anyone would be stressed, the fact that I have Lupus makes the effects worse, and potentially damaging to my health.

Before I really get going, I have to say that the agency and the coordinator have been awesome through this mess.  They’re the ones that have been dealing with this insurance company (heretofore referred to as Evil HMO) and the OB’s office the whole time.  The phone calls, faxes, and all the other crap have been handled by them, trying to get Evil HMO to do what they’re supposed to–and for that, I’m truly thankful.  I can’t imagine how much more of a wreck I’d be if I were the one trying to get this stuff pushed through, because I have no experience trying to make things work with any insurance company, much less Evil HMO.  As far as I’m concerned, the agency has definitely earned its fee and more.

The agency is the one who writes the check to Evil HMO, and does so for 6 months coverage at a time. The policy was purchased early this year, after our GS’s screening but before contracts.  Apparently some moron with Evil HMO’s billing entered the wrong amount of payment on the account.  It wasn’t like the idiot transposed a pair of numbers, either, which I could totally understand.  No, it (I won’t dignify this individual with a gender pronoun) entered the perfect number of $800 for no obvious reason, instead of the $1958.61 (or something like that) we paid by check to cover 6 months.  Apparently when that amount ran out, Evil HMO cancelled the insurance for non-payment–even though they had cashed the check for more than twice that amount.

The whole issue didn’t come to light until the agency and the coordinator started trying 3-4 weeks ago to schedule an OB appointment for our GS.  The agency coordinator (AC) proved to Evil HMO that the check had been cashed, so they were expected to reinstate the insurance and provide services. Evil HMO claimed to have refunded the money (it didn’t show up until late last week), and demanded another check which AC overnighted to them.  But even after the check was delivered, the billing idiots still hadn’t posted it by the next week, so the OB’s office wouldn’t allow us to be put on the schedule.  After a ton of phone calls with all kinds of people, it was agreed last week that we were allowed to schedule, as long as AC promised that the first appointment would be paid for in cash if the insurance hadn’t been straightened out by then, and that Evil HMO would reimburse us when it was fixed.

Then came the kicker–the OB’s office didn’t have any new patient appointments available until August 1st.  That would put our GS at 19w4d, and the last time she had seen a doctor would have been the RE at our ultrasound 9 weeks earlier.  If she were pregnant with a singleton, I still would have been nervous and trying to find a way to get her in earlier. But with twins? UNACCEPTABLE.  AC agreed with me, and managed to get Evil HMO to admit that maybe another OB’s office might have an appointment in 3 weeks, but a lot more conversations would have to take place before an appointment could be made.

At this point, figuring that wouldn’t go anywhere fast, I changed tactics.  I’d heard about NT scans (though I had forgotten what it was called at the time), and knew that they were generally done between 11w0d and 13w6d. It seems that they’re pretty common with surrogacy, although I know of women who had them even though they were pregnant “naturally” and weren’t of advanced maternal age.  Even though we used PGD, there’s still the possibility that something went undetected–and if there is an issue, I’d rather know about it sooner rather than later.  So I asked AC about the scan usually done around now, and if we could get our GS in for one.  She felt it was worth requesting, and pointed out that if it got approved, the GS would have to be seen this week, as she’ll be 14w0d on Sunday.  And by getting a scan, she’d probably need a follow up appointment after that, which would be sooner than the appointment we might get in 3 weeks.

Amazingly enough Evil HMO agreed–maybe because they were sick of hearing from us.  Yesterday we got approval, and were allowed to schedule the scan for today.  So I hopped on a plane to San Diego last night, and will drive up to the scan today.  I’m missing spending our 8th anniversary with my husband, but we agreed that it was more important for me to attend the appointment.  We’ll just celebrate this weekend. 🙂

The tl;dr version:  As the Marine Corps teaches everyone who makes it through boot camp, Persistence beats Resistance.  And if one is pursuing surrogacy (either as an Intended Parent or Surrogate), persistence is mandatory.

Ultrasound #3…

Since the pictures from the 3rd ultrasound arrived in the mail yesterday, I figured that I should probably write about it while it’s on my mind. 😉

The appointment was on May 31st, and the last one at Dr. K’s office.  It was also the first one I didn’t attend, even though I really wanted to.  Surrogacy is an expensive process, though, and we’re being as responsible as we can with our funds–especially since we’re expecting twins–which means we have to pick and choose which appointments I travel to make.

However, I was able to listen in because Dr. K called me right before getting started.  He announced that the babies looked fantastic and healthy, and that their development was great.  In fact, each of them were showing off in a different way.  Baby A was demonstrating some dancing skills and wiggling all over (our GS noted that she felt it, and had actually started feeling movement for the first time the night before).  Baby B decided to wave for the camera, so one of the pictures focused on the head and arm–it’s amazing how much detail is shown, especially for how small they are.

As always, the sound of their heartbeats made me both giddy and a little weak (in a good way :)).  Since I’m not able to feel the babies myself or experience any of the pregnancy symptoms, that sound is the most tangible connection I have with them.  Hearing their hearts beating away is proof that they exist for real, and not just in my dreams.  I have to say, though, that if I already feel like I’m going to melt just at the sound of heartbeats, I’m probably going to need some kind of physical support (like a chair or wall) in the delivery room when they actually arrive!

Stats at 10weeks, 3 days:

Baby A measured at 10w6d (3 days ahead), CRL 35.5mm, and heart rate was 175bpm

Baby B measured at 11w1d (5 days ahead!), CRL 39mm, and heart rate was 171bpm.

Ultrasound #2 (aka the 3 week late update) …

Finally getting around to writing about the 2nd ultrasound, which happened May 17th.  Sorry it took me 3 weeks to do so.  Whoops.

This time I flew into San Diego, and drove the 150 miles to the clinic.  Since I have family in the area, I chose to fly down the night before the appointment and spend a couple of days, rather than repeat the whirlwind trip from 2 weeks earlier.  Unfortunately, this made for a very long day in the car–especially since it’s almost impossible to go through LA twice during daylight hours without hitting traffic.

The appointment was set for noon, and I got to the clinic parking lot at 11:40.  My husband was in Germany for work, but called for a minute to say that he was back in the hotel room and available for a Skype call.  I told him I’d try to use Skype mobile on my phone to contact him, but I wasn’t sure if the cell reception in the office would be up to the task.  If that didn’t work out, though, I had already arranged with the Nurse Coordinator for part of the ultrasound to be recorded and e-mailed to me so he could listen to the heartbeats later.

When I walked in to the clinic, I was surprised to not see our GS.  It was only 10 minutes before the scheduled appointment, and she had been early for the previous 2 appointments.  The real shocker came when I checked in, though, and was told that the ultrasound had already started.  Apparently the NC interpreted my GS showing up 30 minutes early by herself and my request for a recording to mean that I wasn’t going to attend the ultrasound (even though I had communicated my intent to do so the previous day via e-mail).  I’m not even embarrassed to admit that I almost ran over the poor woman whose duty it was to guide me to the correct room.  I had, after all, driven 3 hours that morning to get there–and did not want to miss any more of the ultrasound than I already had.

My entrance interrupted the recording, but at least there was good news available–Dr. K had already looked at both babies, and they were doing great.  He was more than happy to stop things for a moment (although our GS probably wasn’t quite as thrilled, given that this was not an abdominal ultrasound) while I connected with my husband via Skype.  I held the phone up to the monitor’s speaker so he could listen to the heartbeats for the first time, as well as Dr. K’s commentary on each of the babies.  Even though he had seen the pictures from the previous ultrasound, at that moment, I think the pregnancy finally became “real” to him.  I also think that whoever invented Skype deserves an award for giving us that amazing moment.

7 hours’ worth of driving for 7 minutes’ worth of time with the doctor, our GS, and the babies.  Totally worth it. 😀

Stats at 8weeks, 3days:

Baby A measured at 8w3d (spot on), CRL 16.9mm, and heart rate was 175bpm.

Baby B measured at 8w5d (2 days ahead), CRL 18.8mm, and heart rate was 171bpm.